The New York Times reports today on a RAND study that found that government-mandated (and taxpayer-subsidized) electronic medical records don’t save money. I predicted this in my health care reform proposal from 2009, under “Scrap Government-mandated Health Care IT”. Because we as a society were going to invest in IT in the dumbest possible way (hundreds of incompatible systems installed nationwide, each one chosen by busy physicians), there was no way that it could be anything other than a huge waste of money.

The report, the industry, and the country refuse to deal with the deeper issue: why did we ever think that this kind of IT would save money and improve care?

There are two ways to do an electronic health record: structured and unstructured.
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Fundamentally there is not as much value to be obtained by having the ability to do a structured query into multiple patients’ data. Nor is there much value in being able to do a structured query into a single patient’s data. Unless you go to the doctor every day of your life, it really isn’t that hard to scan up and down in a big word processing document or spreadsheet and/or use conventional word processing “find in document” tools and/or use Google Drive’s “search a bunch of documents” tool. I did a quick Google search and learned that the average size of an electronic health record, not counting images (which can easily be stored by date as regular files), is between 1 and 40 MB. The absolute top end of the range is 3-5 GB “for a person with several health issues including images”. In other words, your health record could fit into the memory of a modern toaster oven. [A doctor could keep a complete synced copy of all of his or her patients’ records on a mobile telephone.] Anything this small can be searched pretty easily, either by computer programs or humans.

The New York Times published an article yesterday about how people who donated money to senators and election-related groups such as the Democratic Senatorial Campaign Committee earned billions of dollars in additional profits from selling software that typically has few benefits for patients or society.
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It is a little bit interesting that the New York Times never loses its enthusiasm for Big Government. They publish articles lauding proposals by politicians to spend billions in taxpayer money on something that is supposed to do a lot of good. Then a year later the newspaper will publish an article about how great it is that the do-gooding is actually happening. Then a year or two later the newspaper will do a follow-up about how much or most of the money turned out to be wasted, funneled into the pockets of cronies, etc. These cycles continue, usually about 50 of them in parallel, without the Times ever running an article on how government spending tends to be wasteful and to result in the enrichment of cronies.

Officials at Epic Systems are not commenting on a New York Times report Wednesday that the firm was central in lobbying Congress on a $19 billion “giveaway” to convert all U.S. medical records from paper to computers.

The story contends that executives of the largest digital records companies — including Epic, Cerner and Allscripts — poured hundreds of thousands of dollars into a behind-the-scenes effort to promote the use of electronic records, effectively pushing aside smaller competitors.

Those efforts paid off handsomely in 2009, when legislation promoting the use of electronic medical records was included in President Obama’s economic stimulus bill. The $780 billion package included nearly $20 billion in incentives aimed specifically at software made by Epic and others.

The stimulus package also included penalties for doctors who don’t adopt the new technology. Providers who don’t install electronic records by 2014 will face reductions in their Medicare reimbursements.

As a result, the Times claims a handful of firms are now enjoying tremendous profits even as doctors and hospitals struggle to make the new systems work.

Prior to 2009, the market penetration of conventional EMRs was anemic precisely because these pieces of software did not, and still do not, meet the needs of most healthcare providers, their support staff, and the patients they care for. No one needs subsidies or penalties in order to encourage the sale of products and services that meet the needs of those who would use them.

One of the questions we have routinely come across as we interviewed job candidates over the phone has been whether or not the doctor’s office in question had an electronic medical record. Prospective employees who had worked with EMRs previously are always the first to ask. We’ve were typically forced to confess that this particular practice still makes use of paper charts.